First-then schedules are some of the simplest types of schedules that we use with students with autism and other disabilities. Simply put, it just presents what we need to do now (first) and what we will do next (then). It can be done with pictures, objects, in writing, or using apps. We typically use them in different ways depending on the student. Sometimes we use them for behavior support, such as when we think (or know) that an individual doesn’t want to do something we want them to do.
In that case, we present the thing we want them to do in the “first” and the thing they want to do in the “then.” The idea is to show them a preferred activity or a possible reinforcer to motivate them to complete the thing they don’t want to do. We often will use this type of first-then schedule on a board like the one above or below. We use them proactively (before a problem) and when a student refuses to complete a task.
Ideally using them proactively is the best to avoid having adding the reinforcer (then) in when there is a problem, which could inadvertently reinforce the negative behavior (because it creates a reinforcement opportunity). In the picture above, the first-then board is used to show a student that sitting in his PE class will result in a reward from his token board. The first then board is part of the set of tools his staff use and they keep their tools in a zip up canvas notebook (e.
g., Trapper Keeper) so they are readily at hand. The student has a full day schedule on the front of the notebook and the first-then is used when a problem is anticipated. In pictures on the left, the student is using the first-then schedule as his schedule for the day. In the top picture, you see a binder with first work then pack up. For this student, we started working with him using a full-day schedule that was on the wall.
In working with him for a day, we realized that he was struggling with the number of transitions this created for him and checking his schedule became an antecedent for problem behaviors. Each time he had to go to the wall, check the schedule, go to the check-in board and put on the visual, it was difficult for him to understand the process. The second day we worked with him, we used this first-then schedule.
The schedule itself was on the outside of a notebook and the events of his day were on sheets inside the notebook in order. This allowed the staff working with him to quickly switch out the visuals for each transition. At first we started with the scheduled activity being followed by a reinforcer (e.g., first work with teacher, then play dough). Over time he was able to manage the schedule with just the events of the day and eventually he was able to go into the notebook and change his own schedule.
This greatly increased his independence throughout the day. When we first gave him the notebook, the look of comprehension that came over his face was amazing to see. It seemed as if he was saying, “Oh! Now I get it!” His behavior was significantly better using this schedule than the first one we tried. The picture below is a similar situation and you can see how we stored the schedule on the wall.
This student was not able to independently manage his schedule and he did best when only shown 2 pictures at a time rather than a full-day schedule. For more complex learners this often is a great place to start. A word of caution, however. Don’t start an entire class on first-then notebook schedules at the same time when they haven’t been taught to use them. We tried that one time and were constantly looking for the schedules because the students weren’t independent at keeping track of them.
In short, it was disaster and the next day we broke it down and just started with 2 of the students and then added more as the first ones became independent. You can also use first-then boards to show students what will happen after a desired activity. Helping students to know what is coming next sometimes helps them to make the transition more easily. This next picture is a picture of an app I’ve used on my iPhone and iPad pretty successfully.
I find it to be a great tool for making first-then schedules on the fly. It’s called First Then Visual Schedule and you can find it here for iTunes. It is put out by Good Karma and in looking for the links, I discovered that they have a new app called FTVSHD that allows you to add video as well as choice boards and a timer. They are each $9.99. While that is a bit pricy in apps, I have used the regular First Then app quite frequently.
I haven’t yet tried the FTVSHD so if you have it please leave a note for me in the comments on how you like it. It appears that if you have an iPad you may want to use the new one; the original app just expands to be twice the size on the iPad as it is designed for the iPhone or the iPod Touch. What I like about the first-then app is that sometimes I don’t have pictures handy with me for the right things, but I always have my phone.
The app allows me to snap a quick picture of the items and then put it in a first then schedule (or in a longer schedule). The example below was for a student I was working with who really liked to read books but didn’t really like to work on money skills. I didn’t have a picture to break down the tasks in his work session, so I quick pulled out my phone, snapped pictures of the material, and voila! A first-then schedule.
It really helped him to work through the money task with just a few reminders that he would then be able to look at the book. I don’t typically use this feature, but you can also record words with the pictures so the person using it can hit the picture and it will tell him what is next. Overall, the app is easy to use and can be used to make a variety of different types of schedules. And then we have the low-tech option–you can just draw it out on paper, post-its or dry erase board and use writing if the student can read.
You just want to make sure that the student is able to clearly comprehend what is written. How you decide which one to use really depends on your purpose and the student’s abilities. The video below demonstrates the use of a first-then schedule used for work time, similar to the way I use the app above. It also talks about using a matching schedule that we will talk about later in this series.
[embedded content] [embedded content] And finally, I promised you a freebie! You can use the board with a variety of visuals and you may want to use a previous freebie of the communication visuals from this post as your “then.” Simply download the board, laminate it, and put velcro on it to hold the pictures. Click here or on the picture below to download a copy of a first then board from my TPT store.
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Visual Picture Schedule Example Here we share a visual picture schedule example used to improve learning and understanding for our loved one with autism to prepare him for a trip to the hospital for oral surgery under dental anesthesia. A few weeks before our loved one was admitted to the hospital for oral ambulatory surgery, he needed to be prepared before the event. Although we tried to explain step-by-step those things most likely to happen, we understand that he needs a visual picture schedule to help him better understand the process leading up to most new experiences.
Our family member likes to read and loves being read to. The first step was to find the right children’s book to help us explain to him in a clear, non-threatening manner that children sometimes need to go to the hospital for surgery. The book would also need to tell the story in a way which does not makes him fearful of the hospital. Luckily for us, we found a wonderful classic children’s book Curious George Goes to the Hospital.
When his friend, the ‘man with the yellow hat’ gives Curious George a picture puzzle, poor accident-prone George swallows a puzzle piece and must go to the hospital and have it removed – surgically. The second step was to make a preoperative hospital visit which allowed us to actually take the road trip with our loved one, see the sights, the hospital, visit with a nurse, and meet the anesthesiologist.
We asked the nurse and anesthesiologist to tell us what we could expect to happen from the time we arrived until the time we left to go home after the surgery. They were happy to tell us what to expect on the day of surgery. A phone call with a nurse and anesthesiologist will be helpful if there is no preoperative hospital visit. Based on the information they gave us, the third step was to put together a visual picture schedule we could introduce to our loved one after reading Curious George Goes to the Hospital many, many, many times over -- as a social story.
Below is a visual picture schedule example we made with a 8 ½ x 11 sheet of laminated construction paper with round sticker word and picture icons. If I can't picture it.I can't understand it.Albert Einstein Row 1: The first row of word and picture icons in the visual picture schedule example help us to explain the procedure of having to get undressed to put on a hospital gown, then have a physical examination and preoperative tests.
Row 2: The second row of word and picture icons in the visual picture schedule example help us to explain when it was time for our family member to prepare to go into the operating suite. He would be given a liquid sedative, await the arrival of the surgeon, and an intravenous needle would be inserted into his hand. Row 3: The third row of word and picture icons in the visual picture schedule example help us explain that he must lie down on a gurney to be wheeled into the operating room.
He should not be afraid because he would be fine. He was going into the operating room to go to sleep and get his teeth fixed. Row4: The fourth row of word and picture icons in the visual picture schedule example allowed us to show him while he was still sleepy from the anesthesia that the procedure was finished! And praise him for his bravery. Soon it is time to leave the hospital. However, you will be sit in a wheelchair until you leave the hospital.
Now it’s time to go home! Row 5: The fifth row of word and picture icons in the visual picture schedule example is to show our loved one he will take another dose of medicine to help relieve his discomfort as soon as we get home. A praise is given as a reinforcement for getting through this stressful day. In hindsight there are just a few important facts we could have included in this visual picture schedule example to help us explain: Admitting Office – the place where a plastic bracelet will be put on your wrist.
The bracelet is worn to identify you to all the hospital workers. It will not come off until you leave the hospital. Wait Time – there is a period of wait time after you are admitted to the hospital until the time of surgery. Books, games and other favorite activities for your child is helpful to pass the time – along with lots of patience. Discomfort/Pain – there may be some degree of nausea, discomfort and pain after a medical procedure or surgery.
Feelings/Sensations – whenever teeth are drilled, filled, pulled or capped your mouth may feel differently and will feel better very soon. Visual Picture Schedule Resources Richard John Novak, M.D. Clinical Associate Professor, Stanford Department of Anesthesiology offers information on the effects of children with autism and dental anesthesia, standards of care, drugs commonly used, and how emotionally uncooperative patients are treated.
Practical Visual PictureSchedule Resources The PAC Kit is a downloadable daily Planner, Agenda and Calendar especially designed to help disorganized students at any age get organized with their homework, notes and assignments from school to home and back again. View the visual picture schedule examples we've made for our loved one to help improve learning and understanding both at home and school: Bathroom Visual Picture Schedule, Birthday Party Visual Picture Schedule, and Visual Picture Schedule Example to prepare him for oral surgery and dental anesthesia.
Also see an example of a Visual Classroom Schedule used for our family member with autism as a younger and older student. Return to Autism Articles pagebr> Return to Home page